Best Solutions Health Care Ltd

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This key question has been rated inadequate. We reviewed 6 quality statements for this key question. Care plans were not completed or reviewed. Systems in place did not ensure risks were mitigated. The provider did not comply with principles of the Mental Capacity Act 2005.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they were happy with the care and treatment received, however they were not involved in the planning of care.

Management told us they link with GP’s, District nurses, OT and pharmacist to assess and meet the needs of individuals although we did not find evidence of this in care records. Staff told us that when a person’s needs change, they update the care plan or this is discussed in an email or whatsapp group message. A staff member told us “Carers update the care plans on the phones”, however we found care plans were not reviewed, and daily records were not audited.

Systems were not in place to assess, monitor and mitigate risks to people and keep them safe. Risks associated with care were not always identified including risk of falls, skin integrity, continence, medication, nutrition and hydration. This posed a risk of people being harmed and their health and well being deteriorating. We did not find evidence people were harmed but this was a breach of regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

People and relatives told us they had discussions on what support they needed and preferences prior to receiving care, but they were not involved in their care planning, changes and/or reviews.

Management told us that they involve people in planning and delivering care and treatment, however there was no evidence to support this. Care plans lacked personal preferences and detail.

The provider was unable to demonstrate processes in place supported current legislation and evidence-based good practice.

People and relatives told us if required the provider would access health care professionals if needed however there were no systems in place to guide staff and ensure this.

Management told us they work effectively across teams and services to support people. When needed they would contact other professionals such as social workers and health care professionals. However, records did not contain sufficient information to guide staff on how to support people.

Although we did not receive any concerns from partners and stakeholders we found examples of the provider not referring people to external healthcare professionals when needed.

The service did not always seek support from external healthcare professionals. We saw evidence of effective partnership working with other health professionals in people's daily notes such as the GP and 111 service however, the service did not always contact the GP or other medical professional in relation to refusing medication or reviewing nutritional supplements.

People told us staff did not always support them with their nutritional needs. Staff did not always refer to external professionals to ensure people were supported to live healthier lives.

Management told us that they routinely monitor people’s care and treatment to support people to manage their health and well being. However, there was no evidence audits took place to monitor and support this process.

Processes were not in place to support people to live healthier lives. Nutrition and hydration care plans were blank. We found important information missing meaning peoples food and fluid intake was not monitored.

People and relatives told us they received care from regular staff who knew what they needed and provided appropriate support. However, we found people were not involved in planning their own care.

Although management told us that they routinely monitor care and treatment to continuously improve and ensure outcomes are positive and consistent, there was no evidence to support this. The service had failed to make improvements since our last inspection.

The provider failed to ensure the quality of the care and service provided was effectively monitored. Risk assessments and care plans were not always completed and lacked detail. Care plans were not reviewed therefore we could not be assured the information was up to date. The provider did not take steps to improve the quality and safety of the care provided for example there were no audits in place. We did not find evidence people were harmed but this was a breach of regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

People and relatives did not raise concerns regarding staff asking for consent however we found consent to care was not always obtained .

Management told us they spoke to people about their rights around consent and respect these when delivering person-centred care and treatment. However, processes were not in place to ensure care and treatment was provided with the consent of the relevant person, failing to ensure that the principles of the Mental Capacity Act 2005 were complied with.

The provider did not comply with the principles of the Mental Capacity Act 2005. The provider did not complete Mental Capacity Assessments or Best Interest decisions. During discussions with the registered manager there was a lack of understanding of how and when to complete capacity assessments. We did not find evidence people were harmed but this was a breach of regulation 11 (Need for consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.